**5.5 Effects of fixed combination of insulin degludec and incretin liraglutide (IDegLira)**

Metabolic and cardiovascular benefits of the fixed combination IdegLira were evaluated in studies DUAL and others. [79–87]

#### **Figure 23.**

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

Independently, 4 of other 6 obese persons with IFG/IGT reduced body mass during L supplementation. So, L therapy appears to be a potentially effective approach to prediabetes conditions and its administration should start rather at an

**5.4 Effects of once weekly semaglutide on HbA1c, body mass and well-being**

in clinical studies REWIND and SUSTAIN 1–10, resp.

*Lady, age 60 y, prediabetes. 10-point PG profile before and with L + M [66] (2011).*

Effects of long-acting incretin analogs (exenatid QW, dulaglutid [67] and semaglutide [68–77] on metabolism, cardiovascular and renal protection were described

Our case report (2019–2020) [78] brings insight on benefits of semaglutide in a 79-year-old lady with long-lasting T2D. She has been suffering from both metformin intolerance and insulinofobia. In the course of a long- lasting period of gliptin therapy, the patient's HbA1c concentration increased to 61 mmol/mol. During the following 4-month period with semaglutide, the patient's mean PG concentration

*Lady, age 79 y. Evolution of HbA1c in the course of treatment with saxagliptin, linagliptin and semaglutide,* 

**18**

**Figure 22.**

*resp., 2018 to 2020 [78].*

early stage.

**Figure 21.**

*Lady, age 77 y, T2D since 1985, cast away syndrome. Evolution of HbA1c in the course of different therapy (MDI-CSII-CSII with iSGLT2-IDegLira only) (1997–2020) [88].*

#### **Figure 24.**

*Lady, age 77 y, T2D since 1985, cast away syndrome. Evolution of BM in the course of different therapy (MDI-CSII-CSII with iSGLT2-IDegLira only) (1995–2020) [88].*

**Figure 25.**

*Lady, age 77 y, T2D since 1985, cast away syndrome. Overview of all parameters (HbA1c, BM, insulin/day, MPG) in the course of different therapeutic regimens (MDI-CSII-CSII with iSGLT2-IDegLira only) (1996–2020) [88].*

We deemed IDegLira could be an option for T2D suffering from impaired cognitive functions. We described this condition as "cast away syndrome".

Our case report (1995–2020) [88] pays attention to IDegLira in a 77-year-old woman with T2D. Her diabetes was treated for 33 years (since 1985) including the last seven- year period of effective insulin pump therapy, finally combined with dapagliflozin. Recently, signs of cognitive deterioration ("cast away syndrome") appeared and the patient was unable to operate her insulin pump. Adding IDegLira to previous metformin and dapagliflozin therapy alongside with support of educated family lead to improvement of patient's condition. The final in-patient period (30. 4. - 1. 7. 2020]) with IDegLira 40 IU/d (no CSII, no metformin, no gliflozin) and specialized diabetes care of nursing staff resulted in reduction of HbA1c to 38 mmol/mol (reference range 20–42 mmol/mol) (**Figures 23–25**).
